Most claims are legitimate, but some are fradulent. Therefore, it is appropriate for the adjuster to review all claims for possible fraud. Determining the "fraud probability" of any claim is facilitated when the adjuster is familiar with various fraud indicators.
These indicators should help isolate those claims which merit closer scrutiny. No one indicator by itself is necessarily suspicious. Even the presence of several indicators, while suggestive of possible fraud, does not mean that a fraud has been committed. Indicators of possible fraud are "red flags" only, not actual evidence.
Some claims, although suspicious, may have to be paid for lack of conclusive evidence of fraud; however, they should be referred to NICB for further review.
All vehicle thefts and all sales of total loss salvage sold by your company or left in possession of the claimant at the time of total loss claim settlement should be reported to NICB. Total loss slavage should include the current and four preceding model years as well as older model years if the vehicle is an expensive sports car, a truck-tractor, or any other valuable or luxury vehicle for manual reporting companies. Electronic reporting companies should report all model years.
Indicators of Fraud Concerning the Insured (download the program for the list)
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